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In Vitro Fertilization Debate Heats Up

September 1, 1998

In June 1998 it was announced that a Japanese woman gave birth to twin boys after she and her husband had overcome their infertility with an ovum supplied by the woman's sister. This was Japan's first confirmed case where a woman other than the mother supplied the egg. The Japan Society of Obstetrics and Gynecology (JSOG), which takes the stance that sperm and egg should only come from the couple in question for in vitro fertilizations, criticized this insemination and expelled the doctor who carried out the procedure.

There are, however, many couples who go overseas for the treatment while it remains off-limits in Japan. This case has sparked renewed debate on the legal and ethical issues associated with in vitro fertilization relying on a third-party donor.

Against Medical Society Guidelines
The procedure in question was carried out at a maternity clinic in Suwa, Nagano Prefecture. According to the clinic's head doctor, the mother of the twins was incapable of producing eggs herself, and it was decided to use an externally fertilized ovum from her sister. The doctor administered medicine to the sister to make her produce several eggs, which were then collected and inseminated with sperm from the woman's husband. Three fertilized eggs were then implanted in the woman's uterus.

In spring 1997 the husband and wife, both in their thirties, were blessed with twin boys. The doctor also announced that in addition to this couple, he had successfully carried out in vitro fertilizations for two other couples using a donor's sperm.

In 1983 the JSOG released its ethics guidelines, which limited in vitro fertilization to sperm and eggs obtained from the couple receiving treatment. There are no legal restrictions on the practice, so the guidelines rely on doctors to refrain from performing third-party in vitro fertilizations. Meanwhile, the practice known as artificial insemination by donor, which involves inserting sperm from a third-party donor directly into the uterus, has been common in Japan since it was first performed at Keio University Hospital in 1949. In 1997 the JSOG gave its approval to this treatment, which takes place about 1,000 times a year in Japan.

Heading Overseas
Third-party in vitro fertilization is a common practice in many Western countries. German law allows outside parties to supply only sperm, while England and France permit sperm or eggs. There are no federal regulations dealing with the practice in the United States, but almost every state allows in vitro fertilization using third-party donors. In recent years an increasing number of Japanese couples have been heading overseas to receive this treatment.

One recently established fertility clinic in San Francisco, for instance, reports that around half of the couples it treats are Japanese. And according to one Tokyo organization that has assisted Japanese couples seeking treatment in the United States since 1991, 83 of those couples have given birth to a total of 122 babies. Of that total, 67 births were the result of in vitro fertilization of eggs provided by third-party donors, while 16 relied on donated sperm. Moreover, 39 of the babies were carried to term by surrogate mothers.

Committee to Debate Issues
After the Nagano doctor went against its guidelines by carrying out the procedure, the JSOG revoked his membership. But this decision has been followed by varied discussion among the member physicians of the society. One doctor voiced a typical opinion: "Although Japan has quite advanced in vitro technology, couples suffering from infertility are unable to benefit from it. We should change the guidelines so these patients will not be forced to go overseas for treatment." Another stated: "Social norms change over time. We need to have an open debate on this practice to decide to what extent it should be permitted."

Couples suffering from infertility are split in their opinion on the treatment. Following the announcement by the Nagano clinic, another clinic in Osaka conducted an Internet survey on third-party in vitro procedures. Responses were gathered from 207 people with fertility problems, 184 of them women. A full 73% of the respondents were in favor of the practice; they were followed by 16% with no strong opinion and 11% who were opposed to the treatment. Even among those who approved of third-party fertilizations, however, some felt that they would not like to use the method because they were "worried about how the child would feel when he or she found out the truth of his or her birth." Many of those who opposed the treatment gave such reasons as: "Resorting to the use of an outside ovum or sperm is going against the will of nature."

Spurred by this heightened debate, the JSOG intends to establish a committee to look at the issue of third-party in vitro fertilization. The Ministry of Health and Welfare, too, has announced that it will set up a special council to discuss the procedure and decide an appropriate government approach to the matter.

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Trends in JapanEdited by Japan Echo Inc. based on domestic Japanese news sources. Articles presented here are offered for reference purposes and do not necessarily represent the policy or views of the Japanese Government.

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